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Open enrollment and beyond – how to keep revenue on track all year

Changes in patients’ benefits can wreak havoc on your revenue cycle. Whether those changes are due to open enrollment season, patients switching jobs or companies making changes to their employees’ insurance coverage, clinical practices and hospitals feel the financial burden.

Further, with high-deductible health plans and other cost-sharing responsibilities, many patients are struggling to pay what their plans don’t cover. All too often, collection becomes the problem of the providers. But there are ways to manage patient bad debt and prevent write-offs. Let’s explore a few actions you can take to capture more patient payments and increase cash flow throughout the year.

1. Prepare to capture payments at time of service

Collecting more patient payments starts at a patient’s appointment. First, make sure that you have up-to-date eligibility information. Asking patients at check-in if anything has changed in their insurance, and updating that information before they see their provider, can significantly reduce denials and remits.

At the same time, front office staff can help increase payment collection by informing patients of their financial responsibility upfront. Patients are more likely to pay what they owe when they know what to expect going into their appointment.

Finally, make it easier for patients to pay what they owe – either in office or online – with updated payment options. With card, cash, account-on-file and online options, you can give patients the convenience they need to pay what they owe on time.

2. Extend your bedside manner to revenue conversations

When it comes time to talk about payments with patients, don’t make assumptions about their ability to pay. A 2019 study revealed that more than 65% of bankruptcies were caused by medical debt, and many of those were patients who were homeowners with full-time jobs and insurance coverage.1

With this in mind, be sensitive in these discussions. Just like you would approach a difficult diagnosis with care and patience, do the same when approaching potentially difficult conversations around payments. Understand that, while patients usually know that you don’t set their copay and deductible amounts, patients across the country are experiencing increased frustration and anger around their medical costs. A little empathy and some flexibility in payment options can go a long way.

3. Get to know the laws around payments and reimbursements

Whether you’re dealing with denials due to changing coverage or you’re trying to collect on patient bad debt, it pays to know the laws that impact how you can legally collect on patient debt. The Centers for Medicare & Medicaid Services (CMS), state laws and insurance contracts all have a say in what you collect and how you collect overdue payments.

For example, you may be tempted to waive a patient’s copay if the patient is experiencing financial difficulties. While this seems like a kind gesture, it could result in major repercussions, as it could be construed as fraud by some insurance plans.

4. Follow up on debts and denials to maximize payments

Now, let’s talk about a few things you can do now to strengthen revenue, simply by following up on outstanding claims and payments. As many as 60% of denied claims are never corrected and resubmitted for payment.2 Simply by following up on denied claims, you can increase your revenue capture significantly.

At the same time, you can increase patient payments by collecting as much of each patient’s financial responsibility at the time of service as possible. And, when following up on outstanding debt, give your billers the freedom to offer discounts to give patients incentives to pay what they owe. Between setting up automated payment plans and offering an easier way for patients to get out of debt, you collect more while improving patient satisfaction.

5. Increase clean claims and get paid faster with automated eligibility verification

Finally, you can accelerate your revenue cycle and ensure that you’re not leaving money on the table by increasing your clean claims rate. According to the Council for Affordable Quality Healthcare (CAQH), electronic eligibility verification is “the single biggest savings opportunity for medical providers to reduce administrative costs.”3

Further, a 2020 CAQH report found that providers could save nearly $9 per inquiry, simply by shifting to fully electronic eligibility and benefits checks.4 That may not seem like much, but consider how many patients you see each year and how often you have to verify their insurance coverage to ensure that you don’t submit inaccurate claims. With the right technology, providers can save billers and front office staff significant time and effort by automating eligibility verification.

Discover a suite of tools to automate billing and claims management during open enrollment and year-round

With these tips, you can improve cash flow and decrease patient bad debt throughout the year – and make open enrollment season easier with more efficient billing workflows. Discover how to stay on top of eligibility changes with our free on-demand webinar, 3 Ways to Improve Efficiency with Automated Eligibility Checks.



  1. “This is the real reason most Americans file for bankruptcy,” Lorie Konish, CNBC, February 11, 2019.
  2. “Why getting claims right the first time is cheaper than reworking them,” Timothy Mills, Physician’s Practice, September 9, 2019,
  3. “4 ways to rein in your practice’s hidden billing costs,” Dan Richards, Medical Economics, February 10, 2020, . Cited from CAQH report.
  4. Closing the Gap: The Industry Continues to Improve,
    But Opportunities for Automation Remain, 2020 CAQH INDEX®, pg. 5,

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About the author

David Swenson, Manager, Sales Engineering